- What is the approximate incidence of patent ductus arteriosus per live births?
C) 1: 200
D) 1: 2,000,000
- Typical oxygen saturation in the patient with isolated PDA?
- Pulmonary Vascular resistance isn normalized by ____post birth in full term infant?
A) 12 Weeks
B) 4 weeks
C) 1 day
D) 7 days
- What finding might be present in a PDA patients 12 lead EKG?
A) LV hypertrophy noted in V5 and V6
B) RV hypertrophy
C) right axis deviation, right ventricular hypertrophy, wide QRS, and right bundle branch block
D) Preexcited junctional beats
- What murmur is typically heard in a patient with PDA?
A) normal S1 and S2
B) Continuous flow murmur louder in systole than diastole
C) Continuous flow murmur louder in diastole than systole
D) none of the above
- On physical exam the 3 month old has a HR of 175 beats/min and upon auscultation a continuous murmur is noted- louder of 2nd intercostal space, wide pulse pressure is noted BP is 94/33 pulse are strong and bounding, breath sounds are clear to auscultation, patient is breathing 35 breaths per min, oxygen saturations are 96% on Room air & liver is slightly enlarged palpated. Do you suspect a PDA?
Yes or NO
- The Image is an example of what?
C) Central Cyanosis
D) Differential Cyanosis
- Blood can be on stand-by in blood bank, does not need to be in OR for patients under 5 KG?
True or False
- A 10 Kg patient should be made NPO (nothing by month) ?
A) 8 hours for solids and liquids
B) 6 hours solids and 4 hours clears and MBM
C) 12 hours for solids and liquids
D) 2 hours for solids and liquids
10. Neonates should have IV fluids running after being made NPO of?
C) D 5
D) D 25
11. A PDA can be closed using the following technique?
A) hemoclips clips
B) Ligation with silk
C) Ligation and division
D) all of the above
12. After ligation of the PDA what expected finding do you have for BP?
A) No change
B) Narrowed pulse pressure
C) Widened pulse pressure
D) Elevation in systolic pressure
13. What nerve is located on the medial reflected plural flap?
C) Left recurrent laryngeal nerve
14. What is the most important emergency instrument to have available is intra-operative bleeding occurs?
A) Satinsky clamp
D) towel clamp
15. What position should patient be placed in for PDA ligation surgery?
C) Left posterior Lateral
D) Right posterior lateral
16. A surgical time out should be performed prior to incision?
YES or NO
17. What thing can be performed intra-operatively to help with pain post-op?
A) nothing there should be not be pain
B) Tylenol IV or per Rectum
C) Intercostal Block with bupivacaine
D) Both B & C
18. What would be considered too much drainage from Chest tube?
A) 3 ml/kg/hr first hour & 2 ml/kg proceeding hour
B) 1 ml/kg/hr first hour & 0.5 ml/kg proceeding hour
C) 2 ml/kg/hr first hour and 0.5 ml/kg proceeding hour
D) 1 ml/kg/hr first hour and 1 ml kg/hr proceeding hour
19. What would be a sign that the lymphatic system was affected during surgery?
A) Chest tube changing from Sanguineous to serosanguineous
B) milky drainage from chest tube after second time taking by mouth formula
C) Sanguineous drainage remaining 2 days post-op
D) none of the above
20. Label the diagramː
21. What is a likely finding on a child with a large PDA with laminar flow, either large shunt left to right or with increasing PVR after 12 months of age, showing decreasing shunt flow, decreasing left heart dilatation, decreasing pulse pressures and increasing right ventricular hypertrophy.
A) A very loud diastolic murmur
B) No murmur
C) A very loud systolic murmur
D) None of the above
22. A child 5 year old child arrives in clinic today presenting with differential cyanosis on feet and not upper right body. Clubbing of toes and only left hand.
His HCT 54. Echo reveals a PDA.
You suspect all of the above exceptː
A) he is a great candidate for a PDA ligation and division given his age
B) further evaluation should be done
C) Eisenmanger Syndrome
D) that the echo is incomplete and the chid must have a more complex heart defect
23. A patient with continuous left to right PDA shunt flow by continuous Doppler with high velocity (peak systolic flow indicating below 50 % of systemic pressure by Bernoulli ) plus left atrial and may be left ventricular dilatation. You conclude the patient is a good candidate for PDA ligation? True or False
Answers: 1A, 2C, 3B, 4A, 5B, 6Y, 7D, 8F, 9B, 10C, 11D, 12B, 13C, 14A, 15C, 16Y, 17D, 18A, 19B, 21B, 22A, 23T
20ː A Vagus nerve, Bː Ductus Arteriousis C Left Subclavian D Descending Aorta